Registration

USAGA offers instruction for all ages, beginners as well as advanced. Most classes are set up by age groups unless their skill level puts them in another class. Students get one on one learning in all classes. Your input could help us create new classes, so always share your ideas.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info*

Health Insurance Carrier

Responsible Payee for Acct.*

Driver License #*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *Receive Text Message Notifications

Portal Access (your email is your login)

Email*(Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell # Receive Text Message Notifications

Email(Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*
(format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Transportation

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Skill Notes

Medical Issues

Shirt Size

Short Size

Class Day and Time

Class Day and Time

Special Note: Classes with 5 or less attending on any given class may be shortened to 30 - 45 minutes without notice.
IMPORTANT: Always put what class day and time that you would most likely want to see your child be in !

Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #2
(Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*
(format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Transportation

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Skill Notes

Medical Issues

Shirt Size

Short Size

Class Day and Time

Class Day and Time

Special Note: Classes with 5 or less attending on any given class may be shortened to 30 - 45 minutes without notice.
IMPORTANT: Always put what class day and time that you would most likely want to see your child be in !

Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #3
(Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*
(format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Transportation

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Skill Notes

Medical Issues

Shirt Size

Short Size

Class Day and Time

Class Day and Time

Special Note: Classes with 5 or less attending on any given class may be shortened to 30 - 45 minutes without notice.
IMPORTANT: Always put what class day and time that you would most likely want to see your child be in !

Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #4
(Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*
(format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Transportation

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Skill Notes

Medical Issues

Shirt Size

Short Size

Class Day and Time

Class Day and Time

Special Note: Classes with 5 or less attending on any given class may be shortened to 30 - 45 minutes without notice.
IMPORTANT: Always put what class day and time that you would most likely want to see your child be in !

Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #5
(Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*
(format=mm/dd/yyyy)

Additional Info

Student Email

School

Grade Level

Transportation

Disabilites

Special Needs

Allergies

Medications

Primary Doctor

Skill Notes

Medical Issues

Shirt Size

Short Size

Class Day and Time

Class Day and Time

Special Note: Classes with 5 or less attending on any given class may be shortened to 30 - 45 minutes without notice.
IMPORTANT: Always put what class day and time that you would most likely want to see your child be in !

Required Policies and Agreements

Release of Liability

I fully understand that USAGA staff members are not physicians or medical practitioners of any kind. With the above in mind, I hereby release the USAGA staff to render temporary first aid to my child or children in the event of any injury or illness, and if deemed necessary by the USAGA staff to seek medical help, including transportation by a USAGA staff member and or its representatives, whether paid or volunteer, to any health care facility or hospital, or the calling of an ambulance for said child should the USAGA staff deem this to be necessary.

We, the staff at USAGA recognize our obligation to make our students and their parents aware of the risks and hazards associated with the sport of gymnastics, cheerleading, and dance. Students may suffer injuries, possibly minor, serious, or catastrophic in nature. Gymnastics, Cheerleading, and Dance can be dangerous and can lead to injury!

Parents should make their children aware of the possibility of injury and encourage their children to follow all safety rules and coaches' instructions.

USAGA, its coaches and other staff members, will not accept responsibility for injuries sustained by any student during the course of gymnastics, cheerleading, and dance instruction, or open workouts, or in the course of any exhibition, competition, or clinic in which he or she may participate or while traveling to or from the event.

With the above in mind, and being fully aware of the risks and possibility of injury involved, I consent to have my child or children participate in the programs offered by USAGA. I, my executives or other representatives, waive and release all rights and claims for damages that I or my child may have against USAGA and or it's representative whether paid or volunteer.

I also affirm that I now have and will continue to provide proper hospitalization, health, and accident insurance coverage, which I consider adequate for both my child's protection and my own protection.

I also understand that it is the parent's responsibility to warn the child about the dangers of gymnastics and injury. The parent should warn the child according to what the parent feels is appropriate. USAGA will only warn the child through "Safety Messages" and our teaching style and progressions.

I've read the above and agree.

Release of Liability

I do hereby; for myself, my heirs, executors, and administrators, waive and release any rights and claims for damageI may have against USA Gymnastics Academy facilities, its agents, representatives, successors and assigns for any and all injuries and damages suffered by enrollee and/or relatives/guardians in or at or in connection with these programs.

I've read the above and agree.

Payment Policies

CLASS FEES -USAGA has the capabilities of Auto Draft Banking (debits from your checking or savings account). Payments can also be debited from DEBIT/VISA CARDS, MASTERCARD AND DISCOVER. CASH and CHECKS are always accepted and please ask for your receipt.No refunds-No exceptions! LATE PAYMENT POLICY !!!!!!!! (After 10 days a $10.00 LATE FEE will be added effective August 2018)** NO EXCEPTIONS- Payments can be made over the phone at no additional chargeor on our website(usagymnasticsacademy.com) or you can mail a Money Order or Cashier's Check to USAGA'S Mailing Address: 902 So. SR 19, Ste. # 2, Palatka, FL 32177. Payments can be made at USA Fitness Inc. during non-business hours.*ANY & ALL DELINQUENT ACCOUNTS AFTER 10 BUSINESS DAYS WILL BE BILLED TO CREDIT CARD ON FILE*SUSPENSION OF STUDENT - A past due account balance after 30 days at USA Gymnastics Academy (including balances for any previous season will suspend the season from taking lessons at USAGA . The student may rejoin his or her class once a payment has been made to lower the balance under $125. Late fees will still apply each month until the account is brought to zero.

I've read the above and agree.

Performance Attire Policy

PERFORMANCE ATTIRE POLICY: You will have to pay a Performance Package fee of $70 for our annual show near the end of the school season. Payments will be split into two installments of $35 each to help with your budget. These payments will be due with the Oct. Monthly Class Fee and the Feb. Monthly Class Fee.

Classes follow the same schedule as the Putnam County School System. Monthly fees remain the same because even with holidays all classes receive an average of 4 weeks per billing cycle of physical instruction during the School Year. USAGA will be closed the last week of each school year & one week just before school starts. Weather cancellations - we are abiding by Putnam County Alerts for schools and there are no make -up days for cancellations or change in tuition for unexpected conditions.

I've read the above and agree.

Dress Attire

DRESS ATTIRE- New Policy Eff. August 2018. Proper dress attire must be worn based on class instruction or your child will not be able to participate in class including hair rule & unclean feet. All hair longer than shoulder length MUST be up and secured away from the face. Low ponytails and braids are best. No fancy hair decorations (THEY HURT!) Also, no buns or high ponytails (THEY HURT TOO!)

I've read the above and agree.

Absentees

ABSENTEES- All fees are to be paid in advance for the upcoming payment period ofinstruction and there are no credits or refunds for missed classes. You must now get a MAKE-UP Class Ticket from a coach before attending a make-up class. Give a courtesy call to let us know why your child will not be able to attend class, as well. WE CARE AT USAGA!

I've read the above and agree.

Withdrawals

WITHDRAWALS - Communication needs to be done immediately if your child is not returning to class and all fees paid at time of withdrawal. Withdrawal policy is 30 days from your withdrawal date and all fees are to be paid up on account.

Temporary withdrawals - if you need to pull your child out of class for any given month or more and plan on returning you must continuing paying your normal rate to reserve your child's enrollment. This also applies to injuries or sicknesses which prevent your child from attending class as well.

I've read the above and agree.

Equipment

EQUIPMENT- No one is allowed on any piece of the equipment without proper supervision. This includesbefore, during, and after class. Absolutely no tumbling or horse playing when instructors are not present in the room. SPECTATORS- We encourage all of our parents/guardians to stay and watch class if you choose to. PLEASE do not attempt to talk or "coach" your child while they are participating in class without prior permission from the current instructor.

Additional safety rule for other children not enrolled in USAGA, but present with student: Do not allow children to dart out or participate on the mats while class is in session. This is a big safety rule that everyone needs to follow!